MFM Flashcards
Side effects of indomethacin?
pulmonary hypertension, renal insufficiency, ileal perforation, or NEC
Does transient neonatal MG correlate with severity of maternal dz or level of mom’s titers?
no!
Is NAS severity withdrawal related to amount of opiate exposure?
no!
What additional drug can be used to treat NAS especially if additional cNS sx or if mom had poly-substance use
phenobarbital
symptoms of fetal alcohol syndrome
SHORT palpebral fissures, thin vermilion border, smooth philtrum. Can also cause cardiac (VSD, TOF+PS), CNS abnormalities
Incidence of choroid plexus cysts?
<1% of infants
What medications for GDM cannot be used in pregnancy bc they cross placenta?
metformin and glyburide
Maternal ITP, mom’s platelets are _____, most neonates are affected/unaffected. In Gestational thrombocytopenia, maternal Plt are _____ and most neonates are unaffected/affected
Maternal ITP: mom’s platelets < 70k, most neonates unaffected
Gestational: mom’s platelets > 70k, most neonates unaffected
Pregnant women with mumps or measles are at higher risk of spontaneous abortion?
mumps
What is the dominant thyroid hormone in fetal life?
RT3
In PKU, what improves fetal outcomes?
Low maternal phenylalanine concentrations BEFORE conception
2 vessel cord associations
cardiac and renal anomalies, IUGR, preterm birth. NO fetal demise
Quad screen for T21
Low / high / low / high
AFP / beta HCG, uE3, inhibit A
What is category III tracing?
absent FHR variability AND recurrent lates, recurrent variables, bradycardia, sinusoidal
Fetal alcohol syndrome leads to (growth and development wise)
persistent microcephaly, prenatal/postnatal growth restriction, MR
What is the most accurate measurement to predict fetal GA
fetal crown rump length measured b/w 7-10 weeks gestation
Amniocentesis performed early has increased risk of ______
talipes equinovarus (club foot)
Fetal weight is estimated from ______
abdominal girth, biparietal diameter, head circumference, femur length
Placentas of fetuses that exhibit abnormal doppler flow velocity ______
slender capillaries with decreased capillary loops in gas-exchanging terminal villi
What are components of biophysical profile?
5 categories, score of 2 or 0
NST: 2 accels within 20 mins associated with fetal movements
Fetal body movement: assess for at least 3 fetal movements in 30 min period
Breathing: assess for 30 seconds of continuous breathing during 30 min period
Tone: one extension/flexion cycle of a limb with rapid return to flexed position during 30 min period
Amniotic fluid volume: presence of single pocket > 2 cm
Interpretation of BPP score
10 - well fetus
8 w/ normal AFV: well fetus
8 with decreased AFV: some kind of asphyxia, deliver or recheck soon
6: labor induction if >36 weeks if favorable cervix and normal AFI. Repeat testing in 24 hrs if <36 weeks and cervix unfavorable. Deliver if <6.
4: labor induction if GA>32 weeks. Repeat same day if <32 weeks, deliver is <6
<2: labor induction
What happens when people PPROM between 28-34 weeks?
50% will progress to labor in 24 hrs and 80-90% will progress to labor within 1 week. Try to make it to 34 weeks
Amino acids require active / passive transport against concentration gradient (placenta)
active transport
Antiphospholipid syndrome
autoimmune disease associated with recurrent pregnancy loss, thrombophilia, fetal growth impairment, placental insufficiency, pre-E, and preterm birth.
10-48% of patients with APS also have pre-E. Heparin improves live birth rates but does NOT improve obstetric complications
Disorders that cause oligohydramnios
fetal urinary tract anomalies, placental insufficiency, premature ROM, TTTS, maternal meds (indomethacin, ACE-inhibitors)
Polyhydramnios associated conditions
T18, T21, Turner, Beckwith Wiedemann
T18 quad screen
low / low / low / normal
AFP / beta / estriol / inhibit A
T13 quad screen
trick question - quad screen not helpful
What is low ponderal index signify?
asymmetric growth
Ponderal index = weight (g) x 100 / (crown - heel)^3
What happens to CBC, coags in pregnant women?
Increase in coagulation factors. Unchanged platelets, WBC increased, dilution anemia.
Is there increased maternal infection risk for twins?
no!
Teratogenic effects of maternal ACE inhibitor use
renal tubular dysgenesis, hypoplasia of skull, fetal compression syndrome with limb deformities, pulmonary hypoplasia in setting of oligohydramnios
Fetal effects of PHB, hydantoin, warfarin
PHB - fetal cleft lip/palate, cardiac abnormalities, GU anomalies
Hydantoin - digit and nail hypoplasia, IUGR
Warfarin - nasal hypoplasia and stippled bone epiphysis
Amnion nodosum
lesion of fetal membranes and placenta seen in pregnancies complicated by severe and long-standing oligo. PPROM, TTTS, severe IDM with placental vascular disease can cause
Larger twin in mono-chorionic pregnancies is at risk for ______
HOCM and neuro injury
Vanishing twin syndrome sequelae
higher incidence of preterm birth, lower BW, higher risk of double death, some evidence that Neuro developmental outcomes for surviving twin are most likely to be normal
Placenta produces large # of hormones. What layer and what hormones?
Syncytiotrophoblast - outer layer of blastcocyst.
Produces HcG, human placental lactogen, leptin, progesterone, estrogens, insulin growth factor (but NOT insulin)
Maternal macronutrient deficiency increases risk for ______
T2DM, cardiovascular disease, HTN, dyslipidemia later in life
How does obesity affect gastroschisis frequency?
Obesity DECREASES incidence in gastroschisis
Oral glucocorticoids in pregnancy affects babies
higher rate of preterm birth and low BW
Side effects of maternal valproate use
NTD, cleft palate, hypospadias, craniosynostosis, polydactyly
Marfan syndrome on babies
highest risk for preterm delivery, cervical incompetence, premature ROM
What electrolyte reduces maternal blood lead levels
calcium
Side effects of epidural anesthesia?
maternal hypotension, fever, longer second stage of labor
What maternal condition causes 15-25% cases of polyhydramnios
maternal DM
Fetal hyperglycemia –> increased osmotic diuresis –> fetal polyuria
Therapeutic tx with indomethacin
What is next step for decreased fetal movements?
biophysical profile
IUFD in monochorionic twins –>what sequelae in surviving twin
multi cystic encephalomalacia and multiorgan damage in surviving twin (acute feto-fetal transfusion at time of demise, rapid blood loss from surviving twin to demised twin)
Management of IUFD in monochorionic twins in >24 and <24 weeks
> 24 weeks: counseled about multi cystic encephalomalacia, no interventions available
second trimester single IUFD before viability –> termination can be discussed
Gas exchange at placenta occurs at the ______
microvillus surface
What does sinusoidal tracing typically entail
severe anemia
Late preterm have higher risk of ____
congenital malformations. However less likely to have IUGR compared to term infants
Biggest sequelae of maternal chorio?
endometritis (30%)
Subnecrotizing funisits or chronic chorio = increased risk for ______ (in baby)
chronic lung disease
Leading risk factor for shoulder dystocia?
maternal DM
Risk for external cephalic version?
transplacental hemorrhage
What decreases risk of uterine rupture for TOLAC?
delivery following spontaneous labor
What to do if NST is bad?
BPP or contraction stress test
Next step if polyhydramnios? What AFI level?
AFI > 25. test for diabetes
Where is sugaleal bleed located?
below aponeurosis and above periosteum
In the placenta - maternal vs fetal blood
maternal blood bathes fetal vessels and gives up O2 to fetal blood
Transport across placenta favors lipids or water?
trophoblastic tissue favors lipid soluble
Placenta characteristics throughout pregnancy (thickness / microvilli)
thinner (10 –> 1.7 micro meters) and more villi (600–>1200 10^6) –> allows for better diffusion
How are carbs and amino acids transferred across placenta? NaCl?
Amino Acid - active transport
Carbs - facilitated diffusion (GLUT receptors across concentration gradient)
lipid transport mostly unknown, but probably transplacental
NaCl - simple diffusion (Salt is simple)
K regulated, Ca active transpo
Vasia previa is most likely to happen with
velamentous insertion
Different types of placenta previa
low lying: edge 0-2 cm from cervix
Previa: edge overlapping 3.2 cm cervix
complete - equal parts overlapping
when to deliver placenta accreta
34-36 weeks
what is circumvallate placenta
small chorionic plate with growth of extrachorial tissue - usually does not compromise fetomaternal exchange
velamentous cord insertion
normal pregnancies, the umbilical cord inserts into the middle of the placental mass and is completely encased by the amniotic sac. The vessels are hence normally protected by Wharton’s jelly, which prevents rupture during pregnancy and labor. In velamentous cord insertion, the vessels of the umbilical cord are improperly inserted in the chorioamniotic membrane, and hence the vessels traverse between the amnion and the chorion towards the placenta.Without Wharton’s jelly protecting the vessels, the exposed vessels are susceptible to compression and rupture
medically managed hypothyroidism in mother leads to _____. What to treat with?
euthyroid newborn that becomes hyperthyroid in first week
must observe mother until PTU has metabolized (several days to 1 week)
PTU first trimester (liver toxicity)
MMI thereafter (facial, EA, aplasia cutis, choanal atresia)
Timing of twin gestation formation
Cleavage 1-3 days: Di/Di (morula)
4-8 days: Mono/di (blastocyst)
8-12 days: Mono/mono (implanted blastocyst)
13-15 days: conjoined (embryonic disc)
When to deliver mono-mono twins
32-34 weeks
etiologies for non-immune hydrops
Anemia (ex: parvovirus, feto-maternal hemorrhage, twin-to-twin transfusion)
Cardiac Failure (ex: elevated RA pressure such as tricuspid atresia, heart block, tachyarrhythmia)
Decrease osmotic pressure (ex: syphilis)
Impaired lymphatic drainage (cystic hygroma, chromosomal abnormalities)
DDx of Very Low or Undectectable Maternal Serum Estriol Level
Placental sulfatase deficiency
– Anencephaly
– CAH
–Molar pregnancy
what hormone does hcg mimic?
TSH (same alpha subunit)
How to screen for aneuploidy in 1st trimester?
GA 11-13 weeks
Age plus NT plus serum markers
– Pregnancy-associated plasma protein-A (PAPP-A)
– Beta-hCG
How to screen for aneuploidy in 2nd trimester?
- 15-20 weeks; “quadruple screen”
- Age plus serum markers
– Alpha fetoprotein (AFP)
– Human chorionic gonadotropin (hCG) – Unconjugated estriol (UE3)
– Inhibin-A
When can you do cell-free DNA?
after 10 weeks
Fetal DNA in maternal serum
what type of placenta can identical (monozygotic twins have)
all of the above
Dizygotic is ALWAYS di/di
Describe FHR
- Category I
– Baseline 110-160
– Moderate variability
– No late or variable decelerations - Category III
– Absent variability and any of: - Recurrent late or variable decelerations * Bradycardia
Cat II is everything else
What Is a reactive NST
2 or more accels in a 20 min window
describe a BPP (performed over 30 mins)
0 or 2 points
NST reactive
Breathing >= 30 seconds
Movement >= 3 torso/limbs
Tone >= 1 flex/extend
Fluid >=2 cm
8 or 10 is good
teratogenic effects of warfarin and phenytoin
microcephaly, midface hypoplasia
Categories of drug labeling (2015)
Pregnancy, lactation, females + males of reproductive potential
What US findings concerning for CMV
FGR, VM, echogenic bowel, hepatic/intracranial calcifications, hydrops
